Presentation introducing the Strategy to end AIDS in Fulton County, GA

1. Fulton County Task Force On HIV / AIDS
December 1, 2015
OUR Time Is NOW
Phase I Progress Report:
Building the Strategy to End AIDS
in Fulton County

2. Goals of the Fulton County
Strategy to End AIDS
1. Reduce new HIV infections
2. Increase access to care and improve
health outcomes for people living with
HIV
3. Reduce HIV-related disparities and health
inequities
4. Achieve a more coordinated local
response to the epidemic

3. Persons living with HIV, Fulton County, 2007-2014
0
2000
4000
6000
8000
10000
12000
14000
16000
2007 2008 2009 2010 2011 2012 2013 2014
GA Department of Public Health

4. Fulton County, HIV Health Disparity – 2013
40
43
8
7
White
Black
Hispanic
Other
Georgia Oasis: https://oasis.state.ga.us/oasis/oasis/qryPopulation.aspx
10
68
6
1
14
White
Black
Hispanic
Other
Unknown
Fulton County Population
by Race
New HIV Diagnoses
by Race
GA Department of Public Health

5. Rising New Diagnoses Among
Black Gay and Bisexual Men
GA Department of Public Health

6. 18.7% Are Not Aware of HIV Status
2,824 Persons
in Fulton County Have HIV
But Do Not Know
They Have It

7. HIV Testing Objective
1. Increase the percentage of
people living with HIV
who know their serostatus
to 90%
(NHAS Indicator 1).

8. Diagnosis Occurs Too Late!
HALF
Of Persons
Diagnosed at Grady ED
In 2015, Already Have AIDS

9. HIV Testing Objective
2. Decrease the percentage
of people with AIDS
at the time of diagnosis
to < 10%.

10. We Are Not Following CDC Guidelines!
• HIV testing is not routinely
performed in healthcare settings, as
recommended by CDC and USPSTF
–Most patients who present with AIDS
have been in and out of healthcare
settings but have never been offered
testing

11. HIV Testing in Healthcare Settings
4. Ensure that patients admitted to
hospitals and treated at
outpatient clinics under Fulton
County’s authority are offered
routine opt-out HIV screening as
recommended by CDC and
USPSTF.

12. Targeted HIV Testing
• Many community groups have funding for HIV
testing, but testing is not coordinated
– Same populations tested over and over
– Gaps remain in those not tested
– Low risk people tested
– Some groups dually funded by Fulton and CDC
• High prevalence ZIP codes do not align with
high volume HIV testing

13. HIV Testing Objectives
9. Ensure that 90% of targeted
HIV testing is directed toward
disproportionately affected
populations and high prevalence
geographic areas.

14. HIV Policy Objectives
6. POLICY: Incorporate HIV and STI screening
into student health services for Fulton County
and Atlanta City high schools, as well as colleges
and universities in Fulton County.
7. POLICY: Clarify Georgia law to ensure that it
allows voluntary HIV testing of minors without
parental consent, consistent with laws governing
STI screening.

15. Fulton County, 2014
50
9
5
3
13
18
Black MSM
White MSM
Hispanic MSM
Other MSM
Women*
Other Men*
44
16
3
3
16
18
New diagnoses PLWH
*IDU, het contacts, NIR

16. In 2014…
Over 700
Persons Were Newly Diagnosed
With HIV
In Fulton County

17. HIV Prevention Objectives
21. Decrease the number of new diagnoses by at least
25% (NHAS Indicator 2)
22. Reduce disparities in the rate of new dx by at least
15% in the following disproportionately affected
populations: (NHAS Indicator 9 adapted)
• young black gay and bisexual men
• gay and bisexual men regardless of race/ethnicity
• black females
• transgender women

18. Transgender: The Unknown Demographic
• Do not have good data to even count the
number of HIV+ transgender persons in Fulton
County
• San Francisco (2001)
– 35% of transgender persons had HIV
– 68% of African American transgender persons had
HIV
• WE NEED BETTER DATA!

19. HIV Prevention Objectives
23 & 24. Ensure access to PEP and
PrEP for eligible persons at high
risk of HIV infection.
25. Eliminate perinatal HIV
transmission in Fulton County.

20. HIV Prevention Objectives
27. Increase access to substance use and
mental health treatment for people who
inject drugs.
28. POLICY: Clarify the legality of syringe
exchange for the legitimate medical
purpose of preventing HIV, HBV and HCV,
and other blood-borne infections in Fulton
County.

21. Fulton County, HIV Care Continuum 2014
Among Persons Diagnosed in 2013
0
10
20
30
40
50
60
70
80
90
100
LTC Engaged Retained VS
38%
PLWH as of 2014
• Linkage for persons diagnosed in 2013 (CD4 or VL within 3 months of diagnosis, labs on day of diagnosis are included)
• Engaged: >=1 CD4 or VL during 2014
• Retained: >=2 visits at least 90 days apart during 2014
• Viral suppression (VS): last VL during the 12 month period
• Provisional data, 2014 deaths not yet included
36%
52%
77%

22. Linkage to Care Objectives
32. Increase the
proportion of diagnosed
persons linked to care
within three days to 85%.

23. Retention in Care Objectives
34. Increase the number
of people retained in
care to 90% of those
diagnosed

24. Retention & Reengagement Objectives
37. Reengage individuals
identified as out of care through
Health Information Exchange
sites within 3 days of
identification.

25. Viral Suppression Objectives
39. 40. Increase the proportion of
persons with diagnosed HIV who
achieve and CONTINUOUSLY
maintain HIV RNA levels <200 c/mL
to 80%

26. HIV Workforce
44. Increase the HIV provider
workforce and decrease provider
attrition across care sites in Fulton
County.
45. Expand the use of telemedicine to
support HIV care in Fulton County.

27. Social Determinants
55. HOUSING: Address suboptimal housing such
that <5% of people with HIV are unstably
housed. (NHAS Indicator 7 – adapted)
56-59. Reduce unmet need for
• Affordable transportation
• Food
• Childcare

28. Incarceration
61. A-H. POLICY: Provide access to condoms for
all incarcerated persons; Offer opt-out HIV
testing upon entry at Fulton County jails.
• Education on health, sexuality, and PrEP
• Pre-release referrals for housing, mental
health and substance use treatment, and
other services
• Stop stigmatizing people with HIV

29. Education
61. C. Implement evidence-based
comprehensive sex and sexuality
education for youth (ages 10-17) in
Fulton County schools.
Abstinence-based Education Does Not
Work!

30. Reducing Stigma and Discrimination
63. C. Reduce the experience of stigma and
discrimination (gender/sexual identity and
expression, race/ethnicity, and socioeconomic
status) among PLWHA in
• Healthcare institutions
• Educational institutions
• Criminal justice systems
• Faith institutions
• Government institutions

31. Reform HIV Criminalization Laws
63.D. POLICY: Reform HIV
criminalization laws to align with
current HIV science and advance
best public health practices for HIV
prevention and care.

32. FCDHW Objectives
• Ensure transparency regarding the use of
federal, state, and county funds impacting HIV,
STIs, VH, and TB by FCDHW.
• Ensure that structural changes affecting
communicable diseases and RWHAP-funded
services at FCDHW include a transparent and
public process for input from program staff
and stakeholders, and collaborative planning.
• Revise hiring, contracting, grants practices

33. Phase II
• Refine Objectives to make them achievable
and measurable
• Design Action Plans to guide implementation
• Prioritize among Action Plans
• Conduct Resource Analysis to identify all
available resources that may contribute
• Conduct a Gap and Cost Analysis to identify
what is needed

34. They ARE Doing It.
• South Africa decreased new HIV diagnoses by
58% from 2009-2014
• Washington DC decreased its new HIV diagnoses
by 57% over 8 years
• Cuba eliminated mother to child HIV transmission
in 2015
• New York is planning to “End the Epidemic” by
2020
• San Francisco has committed to “Getting to Zero”
new infections

35. We Have the
Same Tools!

36. Do We Have the
Political Will?

37. We CAN Do This.
Will We?
OUR Time is Now!

38. Contact the Task Force!
fchatf.gov@gmail.com

39. Fulton County Task Force On HIV / AIDS
December 1, 2015
OUR Time is NOW!
Introducing the Strategy to End AIDS
in Fulton County